Journal of Bone and Mineral Metabolism

, Volume 30, Issue 5, pp 493–503 | Cite as

Time to onset of efficacy in fracture reduction with current anti-osteoporosis treatments

  • Charles A. Inderjeeth
  • Kien Chan
  • Kevin Kwan
  • Michelle Lai
Review article


Early prevention of future fracture is an important goal in those at risk. A similar 3-year fracture efficacy is reported for most osteoporosis agents. Onset of fracture efficacy may be useful to help tailor treatment based on risk. We reviewed the peer-reviewed literature for onset of fracture efficacy data on the commonly prescribed osteoporosis treatments. All papers were reviewed independently by at least two reviewers for onset of efficacy for morphometric vertebral fracture (MVF), clinical vertebral fracture (CVF), nonvertebral fracture (NVF), hip fracture, and any clinical fracture (ACF). Alendronate is reported to reduce multiple CVF by 6 months; all CVF, NVF, and multiple ACF by 12 months; and all ACF and hip fracture by 18 months. Ibandronate is reported to reduce MVF by 12 months and NVF by 36 months. Raloxifene is reported to reduce CVF by 3–6 months and NVF by 36 months. Risedronate is reported to reduce CVF and NVF by 6 months, and hip fracture by 12 months. Strontium ranelate is reported to reduce MVF, CVF, NVF, and ACF by 12 months, and hip fracture by 36 months. Zoledronic acid is reported to reduce MVF, CVF, and ACF by 12 months, NVF by 24 months, and hip fracture by 36 months. Although direct comparisons are limited, based on the available literature, risedronate, followed by alendronate, have the earliest onset of benefit across the range of fracture types. Onset of efficacy may be an important consideration in the selection of treatment for some patients.


Osteoporosis treatment Fracture reduction Time to onset Efficacy 



This paper was funded by Sanofi-Aventis Australia through an investigator-initiated grant. Although Sanofi-Aventis had an opportunity to review the paper before publication, the authors take full responsibility for the content of the paper and have not been influenced by the sponsor.

Conflict of interest

C.A. Inderjeeth, advisory, research funding and/or speaker fees received from Amgen, Eli Lilly, Merck Sharp and Dohme, Roche/GSK Australia, Sanofi-Aventis, and Servier Laboratory Australia; K. Chan, none to declare; K. Kwan, none to declare; M. Lai, none to declare.


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Copyright information

© The Japanese Society for Bone and Mineral Research and Springer 2012

Authors and Affiliations

  • Charles A. Inderjeeth
    • 1
  • Kien Chan
    • 2
  • Kevin Kwan
    • 2
  • Michelle Lai
    • 2
  1. 1.Area Rehabilitation and Aged Care, North Metropolitan Health ServiceUniversity of Western AustraliaPerthAustralia
  2. 2.Sir Charles Gairdner HospitalPerthAustralia

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